Christopher was at London’s King’s College Hospital receiving another round of treatment for lymphoma when he first heard about AV1, a robot developed by the organisation No Isolation. It was Christopher’s A-Level year and he was determined to finish at least one of the three he was doing. AV1 could help him stay in touch with school, ensuring he did not become isolated while recovering at home.
With the help of the Chartwell Cancer Trust charity, Christopher got the robot. “It sat in the classroom at school and I had the software on my laptop,” he says, which meant that from the hospital he could speak in lessons and participate with fellow students. “This was before Covid, so before online learning became a thing,” he adds. “It was a really positive experience and a really positive tool.”
Robot use in health and social care is on the rise, with the medical robot market predicted to grow to $16bn by 2025. Robots are helping to perform surgery, connect young people to school, and tackle isolation among older people. But will the costs of robotic equipment open up inequalities between those who can afford the latest technology and those who cannot?
In 2019 The Topol Review looked at how the healthcare workforce needed to change to prepare for a digital future. At the end of that year, the government announced £34m in funding for research into care robots, saying they could “revolutionise” the system. In his report, however, Eric Topol of the Scripps Research Institute, noted that new technologies should “redress not reinforce inequalities”. This issue was already starting to emerge with personal tech, such as Fitbits, which help people keep track of their fitness. In 2019 the Social Market Foundation called for these types of devices to be made available on prescription to ensure everyone who needed one could have access.
The evidence does show that robots can address health and social care needs that disproportionately affect poorer people, such as poor mental health. Chris Papadopoulos of the University of Bedfordshire ran a study where Pepper, a humanoid robot, was trialled with people in care homes in the UK and Japan.
The project took an existing robot and programmed it with a much more sophisticated version of software designed to be “culturally competent and autonomous” so it could communicate as naturally as possible with frail, older adults, explains Papadopoulos. Pepper remembered and responded to the preferences of users, so a cricket fan, for example, would not be repeatedly asked about the football.
The Pepper robots in the care homes “significantly improved” the mental wellbeing of the older people who used them, according to data Papadopoulos and his team collected. They were not initially sure if loneliness would decrease, he says, but the impact was positive, while less significant than the impact on mental well-being. What was also interesting, Papadopoulos noted, was that those who took part became more positive about the use of robots in social care. He believes “social robotics” has the potential to help address health inequalities, but “only if leveraged in a fair and equitable way”. For this to happen, governance and quality assurance standards are needed to “ensure that all people can access these technologies should they wish to”.
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Lynne Baillie works at Heriot-Watt University, which hosts the National Robotarium, a research and development facility for robotic and autonomous systems. The centre received £3m of the government’s £34m investment into social care robots. Baillie has been working with Chest Heart & Stroke Scotland to see how robotics can support stroke survivors, and with a housing association on how robots can help in responding to falls in the home.
One of the aims of the National Robotarium, she explains, is to convene robotics researchers, policymakers, clinicians and other stakeholders to help develop technology and have policy discussions at an early stage, instead of building tech in silos. Inequalities in access are also of concern for Baillie, who notes wealthier and more educated people tend to get better access to care. There needs to be research and action to ensure robotics are “accessible and available” to everyone as they come into wider use, she says.
Trust and security are also important considerations. Baillie and her team have been working with psychologists on these issues, as well as ensuring their own work is ethical and only collecting necessary data. “We want to make sure that we have privacy by design,” she explains, citing issues with Alexa, Amazon’s voice-activated assistant, collecting data on users.
Assistive robots are one step on from assistive technology, says Kathryn Smith of the Social Care Institute for Excellence (SCIE). She thinks both can be embraced as a “complementary addition in health and social care, but not replace human contact where that is needed”.
Access to assistive technology has long been an issue in social care. Clenton Farquharson, one of SCIE’s trustees, says that any new technology needs “a rights-based approach”. As well as accessibility and usability, manufacturers and providers should also be mindful of making assumptions about users’ needs, he says – particularly for marginalised groups. One of the reasons why these efforts could fall short, he explains, is that “the most marginalised are often not around the table”.
There is great potential for robotics, together with people, to transform health and social care. As the population ages, they can help us lead lives of our choice. It seems inevitable that, as new technologies come onto the market, they will be used. Policymakers will need to make sure that they are available to those who need them.
This article originally appeared in the Spotlight report on healthcare. You can download the full edition here.